Internal Medicine COMAT Review
Questions With Correct Answers
ECG |leads |representing |anterior |wall |- |CORRECT |ANSWER✔✔-V1-4 |(LAD)
ECG |leads |representing |the |inferior |portion |of |the |heart |- |CORRECT |ANSWER✔✔-II, |III, |and |
aVF |(right |coronary |artery)
ECG |leads |representing |the |lateral |myocardial |wall |- |CORRECT |ANSWER✔✔-I, |AVL, |V5, |& |V6
When |should |you |consider |immediate |diagnostic |coronary |angiography? |- |CORRECT |
ANSWER✔✔-order |immediate |diagnostic |coronary |angiography |for |a |STEMI |or |new-onset |Left |
BBB
Another |name |for |angioplasty... |- |CORRECT |ANSWER✔✔-Primary
In |an |acute |inferior |wall |myocardial |infarction, |occlusion |of |which |coronary |artery |is |usually |
implicated? |- |CORRECT |ANSWER✔✔-Right |coronary |artery
Difference |in |sounds |between |COPD |and |pulmonary |edema/interstitial |lung |disease. |- |
CORRECT |ANSWER✔✔-Wheezing |or |rhonchi= |more |suggestive |of |COPD
Crackles= |more |suggestive |of |pulmonary |edema |or |interstitial |lung |disease.
Most |common |cause |of |an |S3 |heart |sound |- |CORRECT |ANSWER✔✔-CHF
,What |are |S3 |heart |sounds |- |CORRECT |ANSWER✔✔-S3 |results |from |increased |atrial |pressure |
leading |to |increased |flow |rates, |as |seen |in |congestive |heart |failure, |which |is |the |most |common
|cause |of |an |S3 |heart |sound.
causes |of |a |mid-systolic |non-radiating |murmur |- |CORRECT |ANSWER✔✔-High |output |states |
(anemia, |fever, |thyrotoxicosis, |pregnancy).
Aortic |stenosis |(ejecting |systolic |murmur |that |radiates |to |carotids).
Aortic |sclerosis |(valve |thickening |w/o |outflow |obstruction).
Pulmonic |stenosis
Hypertrophic |cardiomyopathy |(consider |in |younger |patients).
Where |is |aortic |regurgitation |auscultated? |- |CORRECT |ANSWER✔✔-It's |an |early |DIASTOLIC |
murmur |heard |in |the |2nd |LEFT-upper |sternal |border.
Indications |for |ordering |an |echocardiogram |- |CORRECT |ANSWER✔✔-1. |Patient |is |symptomatic |
w/murmur.
2. |Pt |has |continuous |murmur.
3. |Pt |has |diastolic |murmur |
4. |Pt |has |murmur |w/intensity |>3/6.
Radiographic |signs |seen |occasionally |in |PE |- |CORRECT |ANSWER✔✔-Hampton |hump |(shallow |
wedge-shaped |opacity |in |the |periphery |of |the |lung |w/its |base |against |the |pleural |surface).
,Westermark |sign=sign |that |represents |a |focus |of |oligemia |(leading |to |collapse |of |vessel) |seen |
distal |to |a |PE. |It's |due |to |a |combo |of |dilation |of |the |pulmonary |arteries |proximal |to |the |
embolus |& |collapse |of |the |distal |vasculature |creating |the |appearance |of |a |sharp |cut |off |on |
CXR.
Why |can |TSH |be |helpful |in |diagnosing |heart |failure |- |CORRECT |ANSWER✔✔-Severe |
hypothyroidism |can |cause |CHF.
Hyperthyroidism |can |cause |high |output |HF.
Medications |that |have |been |shown |to |decrease |mortality |in |systolic |heart |failure |- |CORRECT |
ANSWER✔✔--ACE |inhibitors
-ARBs |(angiotensin |receptor |blockers)
-Beta |blockers
-Aldosterone |blockers
-Hydralazine |& |nitrates
Goal |of |treating |hypertensive |urgency |- |CORRECT |ANSWER✔✔-BP |reduction |of |25% |in |the |first
|few |hours |to |day |in |order |to |avoid |reducing |the |BP |too |quickly.
Roth |spots |- |CORRECT |ANSWER✔✔-Retinal |hemorrhages |w/pale |centers...usually |seen |in |
bacterial |endocarditis
Definition |of |metabolic |syndrome |- |CORRECT |ANSWER✔✔-Any |three |of |the |following |five:
1. |Fasting |plasma |glucose |> |100 |mg/dL |(or |on |medical |therapy |for |hyperglycemia)
2. |BP |≥ |130/85 |mmHg |(or |on |medical |therapy |for |hypertension)
3. |Triglycerides |≥ |150 |mg/dL |(or |on |medical |therapy |for |hypertriglyceridemia)
4. |High |density |lipoprotein |(HDL) |cholesterol |< |40 |mg/dL |for |men, |< |50 |mg/dL |for |women |(or |
on |medical |therapy |for |low |HDL |cholesterol)
, 5. |Abdominal |obesity |(waist |circumference |> |40" |for |men, |> |35" |for |women)
4 |groups |of |ppl |most |likely |to |benefit |from |statin |therapy |- |CORRECT |ANSWER✔✔-1. |current |
ASCVD |(atherosclerotic |vascular |dz)
2. |LDL |cholesterol |> |190
3. |Diabetes |(type |1 |or |2) |ages |40-75
4. |Estimated |10-year |ASCVD |risk |by |pooled |cohort |equations |>7.5%
Well's |Criteria |- |CORRECT |ANSWER✔✔-Criteria |for |diagnosing |a |DVT:
A |point |each |for |(1) |localized |tenderness, |(2) |asymmetric |pitting |edema, |and |(3) |asymmetric |
calf |swelling
*Virchow's |Triad |- |CORRECT |ANSWER✔✔-Risk |for |DVT
Triad= |
1. |Stasis
2. |Vascular |Injury
3. |Hypercoagulability
Arterial |Blood |Gas |(ABG) |in |a |PE |patient |- |CORRECT |ANSWER✔✔-Arterial |blood |gases |(ABGs) |
in |pulmonary |thromboembolism |usually |reveal |an |acute |respiratory |alkalosis |secondary |to |
hyperventilation.
Timeframe |for |acute |vs |chronic |arthritis |- |CORRECT |ANSWER✔✔-Acute |<6 |weeks
Chronic |>6 |weeks
Rhonchi |- |CORRECT |ANSWER✔✔-Low-pitched, |continuous |sounds |often |described |as |similar |
to |a |snoring |sound. |Generated |by |narrowing |of |larger |airways |due |to |mucus |from |bronchitis |
or |narrowing |from |asthma |or |COPD
Questions With Correct Answers
ECG |leads |representing |anterior |wall |- |CORRECT |ANSWER✔✔-V1-4 |(LAD)
ECG |leads |representing |the |inferior |portion |of |the |heart |- |CORRECT |ANSWER✔✔-II, |III, |and |
aVF |(right |coronary |artery)
ECG |leads |representing |the |lateral |myocardial |wall |- |CORRECT |ANSWER✔✔-I, |AVL, |V5, |& |V6
When |should |you |consider |immediate |diagnostic |coronary |angiography? |- |CORRECT |
ANSWER✔✔-order |immediate |diagnostic |coronary |angiography |for |a |STEMI |or |new-onset |Left |
BBB
Another |name |for |angioplasty... |- |CORRECT |ANSWER✔✔-Primary
In |an |acute |inferior |wall |myocardial |infarction, |occlusion |of |which |coronary |artery |is |usually |
implicated? |- |CORRECT |ANSWER✔✔-Right |coronary |artery
Difference |in |sounds |between |COPD |and |pulmonary |edema/interstitial |lung |disease. |- |
CORRECT |ANSWER✔✔-Wheezing |or |rhonchi= |more |suggestive |of |COPD
Crackles= |more |suggestive |of |pulmonary |edema |or |interstitial |lung |disease.
Most |common |cause |of |an |S3 |heart |sound |- |CORRECT |ANSWER✔✔-CHF
,What |are |S3 |heart |sounds |- |CORRECT |ANSWER✔✔-S3 |results |from |increased |atrial |pressure |
leading |to |increased |flow |rates, |as |seen |in |congestive |heart |failure, |which |is |the |most |common
|cause |of |an |S3 |heart |sound.
causes |of |a |mid-systolic |non-radiating |murmur |- |CORRECT |ANSWER✔✔-High |output |states |
(anemia, |fever, |thyrotoxicosis, |pregnancy).
Aortic |stenosis |(ejecting |systolic |murmur |that |radiates |to |carotids).
Aortic |sclerosis |(valve |thickening |w/o |outflow |obstruction).
Pulmonic |stenosis
Hypertrophic |cardiomyopathy |(consider |in |younger |patients).
Where |is |aortic |regurgitation |auscultated? |- |CORRECT |ANSWER✔✔-It's |an |early |DIASTOLIC |
murmur |heard |in |the |2nd |LEFT-upper |sternal |border.
Indications |for |ordering |an |echocardiogram |- |CORRECT |ANSWER✔✔-1. |Patient |is |symptomatic |
w/murmur.
2. |Pt |has |continuous |murmur.
3. |Pt |has |diastolic |murmur |
4. |Pt |has |murmur |w/intensity |>3/6.
Radiographic |signs |seen |occasionally |in |PE |- |CORRECT |ANSWER✔✔-Hampton |hump |(shallow |
wedge-shaped |opacity |in |the |periphery |of |the |lung |w/its |base |against |the |pleural |surface).
,Westermark |sign=sign |that |represents |a |focus |of |oligemia |(leading |to |collapse |of |vessel) |seen |
distal |to |a |PE. |It's |due |to |a |combo |of |dilation |of |the |pulmonary |arteries |proximal |to |the |
embolus |& |collapse |of |the |distal |vasculature |creating |the |appearance |of |a |sharp |cut |off |on |
CXR.
Why |can |TSH |be |helpful |in |diagnosing |heart |failure |- |CORRECT |ANSWER✔✔-Severe |
hypothyroidism |can |cause |CHF.
Hyperthyroidism |can |cause |high |output |HF.
Medications |that |have |been |shown |to |decrease |mortality |in |systolic |heart |failure |- |CORRECT |
ANSWER✔✔--ACE |inhibitors
-ARBs |(angiotensin |receptor |blockers)
-Beta |blockers
-Aldosterone |blockers
-Hydralazine |& |nitrates
Goal |of |treating |hypertensive |urgency |- |CORRECT |ANSWER✔✔-BP |reduction |of |25% |in |the |first
|few |hours |to |day |in |order |to |avoid |reducing |the |BP |too |quickly.
Roth |spots |- |CORRECT |ANSWER✔✔-Retinal |hemorrhages |w/pale |centers...usually |seen |in |
bacterial |endocarditis
Definition |of |metabolic |syndrome |- |CORRECT |ANSWER✔✔-Any |three |of |the |following |five:
1. |Fasting |plasma |glucose |> |100 |mg/dL |(or |on |medical |therapy |for |hyperglycemia)
2. |BP |≥ |130/85 |mmHg |(or |on |medical |therapy |for |hypertension)
3. |Triglycerides |≥ |150 |mg/dL |(or |on |medical |therapy |for |hypertriglyceridemia)
4. |High |density |lipoprotein |(HDL) |cholesterol |< |40 |mg/dL |for |men, |< |50 |mg/dL |for |women |(or |
on |medical |therapy |for |low |HDL |cholesterol)
, 5. |Abdominal |obesity |(waist |circumference |> |40" |for |men, |> |35" |for |women)
4 |groups |of |ppl |most |likely |to |benefit |from |statin |therapy |- |CORRECT |ANSWER✔✔-1. |current |
ASCVD |(atherosclerotic |vascular |dz)
2. |LDL |cholesterol |> |190
3. |Diabetes |(type |1 |or |2) |ages |40-75
4. |Estimated |10-year |ASCVD |risk |by |pooled |cohort |equations |>7.5%
Well's |Criteria |- |CORRECT |ANSWER✔✔-Criteria |for |diagnosing |a |DVT:
A |point |each |for |(1) |localized |tenderness, |(2) |asymmetric |pitting |edema, |and |(3) |asymmetric |
calf |swelling
*Virchow's |Triad |- |CORRECT |ANSWER✔✔-Risk |for |DVT
Triad= |
1. |Stasis
2. |Vascular |Injury
3. |Hypercoagulability
Arterial |Blood |Gas |(ABG) |in |a |PE |patient |- |CORRECT |ANSWER✔✔-Arterial |blood |gases |(ABGs) |
in |pulmonary |thromboembolism |usually |reveal |an |acute |respiratory |alkalosis |secondary |to |
hyperventilation.
Timeframe |for |acute |vs |chronic |arthritis |- |CORRECT |ANSWER✔✔-Acute |<6 |weeks
Chronic |>6 |weeks
Rhonchi |- |CORRECT |ANSWER✔✔-Low-pitched, |continuous |sounds |often |described |as |similar |
to |a |snoring |sound. |Generated |by |narrowing |of |larger |airways |due |to |mucus |from |bronchitis |
or |narrowing |from |asthma |or |COPD
